Phacoemulsification with combined capsular tension ring, supracapsular glued IOL, and optic capture in progressive subluxations for expanding and immobilizing the capsular bag

To report and assess a new technique of phacoemulsification with capsular tension ring (CTR), supracapsular intra-scleral haptic fixation (ISHF), and optic capture in eyes with progressive subluxations and to assess stability of capsular bag-CTR-IOL optic complex. Cases with progressive subluxation first underwent phacoemulsification with CTR implantation. Supracapsular ISHF in the form of glued IOL was then performed by externalizing the haptics through a plane below the iris and above the anterior capsule via sub-flap sclerotomies created 180 degrees apart as for glued IOL. Intra-scleral haptic tuck together with optic capture of the supracapsular glued IOL was then performed. Patients were followed up for safety and stability. Five patients underwent surgery successfully. All had more than one quadrant subluxation. All eyes had well-centered IOL with adequate haptic tuck and no significant tilt. Optic capture was successful in all. Uncorrected distance visual acuity (DVA) improved from 0.18 ± 0.18 to 0.65 ± 0.36, and spectacle-corrected DVA improved from 0.59 ± 0.33 to 0.83 ± 0.24. Post-operative intraocular pressure was 17 ± 3.08, and there was no evidence of any uveitis at the 1-month visit. The anterior capsule opacified around the captured optic; however, the bag continued to remain expanded with stable IOL centration at 1-year follow-up. Phacoemulsification with CTR followed by supracapsular ISHF with optic capture is a viable technique for progressive subluxations. This technique spares the vitreous cavity thus decreasing the risk of posterior segment complications. It expands and immobilizes the capsular bag-CTR-IOL optic complex and has shown good results at 1-year follow-up.